Medication-related osteonecrosis of the jaw (MRONJ) is a severe adverse drug reaction, consisting of progressive bone destruction in the maxillofacial region of patients. ONJ can be caused by two pharmacological agents: Antiresorptive (including bisphosphonates (BPs) and receptor activator of nuclear factor kappa-B ligand inhibitors) and antiangiogenic. MRONJ pathophysiology is not completely elucidated. There are several suggested hypothesis that could explain its unique localization to the jaws: Inflammation or infection, microtrauma, altered bone remodeling or over suppression of bone resorption, angiogenesis inhibition, soft tissue BPs toxicity, peculiar biofilm of the oral cavity, terminal vascularization of the mandible, suppression of immunity, or Vitamin D deficiency. Dental screening and adequate treatment are fundamental to reduce the risk of osteonecrosis in patients under antiresorptive or antiangiogenic therapy, or before initiating the administration. The treatment of MRONJ is generally difficult and the optimal therapy strategy is still to be established. For this reason, prevention is even more important. It is suggested that a multidisciplinary team approach including a dentist, an oncologist, and a maxillofacial surgeon to evaluate and decide the best therapy for the patient. The choice between a conservative treatment and surgery is not easy, and it should be made on a case by case basis. However, the initial approach should be as conservative as possible. The most important goals of treatment for patients with established MRONJ are primarily the control of infection, bone necrosis progression, and pain. The aim of this paper is to represent the current knowledge about MRONJ, its preventive measures and management strategies.
A tooth preparation technique in fixed prosthodontics for students and neophyte dentists sonal experience with the novel technique. It could helps dental students and neophyte dentists in their learning curve.Key words: tooth preparation, fixed prosthodontics, dental education, prosthodontics. IntroductionTooth preparation for fixed prosthesis is a common procedure in clinical practice, which all general dentists should perform correctly. However, it could be difficult to obtain always a predictable result, especially for dental students or young doctors: they could make mistakes in their learning curve leading to inadequate results. Unlike other human substance, dental tissues don't have regenerative capacity. Therefore, the removal of dental biological material should be planned and executed with maximum attention (1). The purpose of a fixed prosthodontic therapy may vary from the restoration of a single tooth to the rehabilitation of the complete occlusion. A single tooth can be fully restored both functionally and aesthetically. A missing tooth can be replaced by a fixed prosthesis, increasing patient masticatory competence and maintaining or improving dental arches function, often elevating patient's self-image (2). Tooth preparation should have specific geometrical characteristics to provide necessary retention and resistance to the vertical and lateral forces acting on the restoration. The most important element of retention is the presence of two opposing vertical surfaces. The axial walls of the preparation should taper slightly to allow the cementation of the artificial crown. The more parallel are the axial walls the greater is the retention. However, it is impossible to obtain parallel surfaces without producing undercuts. Goodacre et al. (3) suggest an angle of convergence between 10 and 20°. Moreover, the occlusocervical length is another fundamental factor for both retention and resistance. The longer is the preparation the greater is the retention. Teeth with larger diameter need a greater length to prevent dislodgement (4). Proper occlusal and axial reductions are essentials to provide enough space, allowing a good functional morphology and structural durability. Moreover, no more than necessary dental tissues should be removed in order not to jeopardize tooth structure and retention of the restoration (2). Preston (5) and Miller (6) suggest starting the tooth preparation producing depth-orientation groves on the vestibular and incisal surfaces, with a round-end tapered diamond as reference for removing tooth structure. The occlusal reduction is performed by removing the tooth por- SummaryPurpose. The aim of this study was to evaluate a novel technique of tooth preparation in fixed prosthodontics suitable for dental students and neophyte dentists. Materials and methods.Twenty-four dental students of the sixth-year class were recruited to verify the predicibility of this technique. Each student prepared two mandibular second premolars on a typodont for a dental crown with a 90° shoulder finishin...
The success of a dental implant treatment requires hard and soft tissue integration and osseointegration, mechanisms that entail a direct anchorage of the implant in the bone without interposition of soft tissue. Peri-implantitis is defined as an inflammatory reaction of the tissues surrounding a functioning dental implant. During inflammation, a high incidence of autoantibodies has been reported. The hypothesis of the present study is that the occurrence of autoantibodies to self-antigens including extracellular matrix (ECM) molecules and heat shock proteins (HSPs) might affect the dental implant outcome. Therefore, we evaluated the occurrence of antibodies to ECM molecules (Collagen (C) I, III, IV, V, fibronectin, laminin) and HSPs (HSP 27, HSP 65, HSP 90) in subjects with a healthy peri-implant microenvironment (n=29) as compared to patients with peri-implantitis (n=13). We also evaluated the HSP 27 expression in gingival fibroblasts grown in an inflammatory microenvironment. Antibodies to conformational ECM epitopes of CI, CIII and laminin were observed both in subjects with healthy peri-implant conditions and peri-implantitis. Antibodies to more than one HSP linear epitope were found in patients with peri-implantitis but not with healthy peri-implant conditions (p=0.024). Gingival fibroblasts grown in an inflammatory microenvironment showed increased HSP 27 cytoplasmic and plasma membrane expression as compared to fibroblasts grown in normal conditions. Immunity to multiple linear HSPs epitopes in patients with peri-implantitis and not in patients with a healthy peri-implant microenvironment might be relevant for monitoring the implant outcome and help to understand the role of subsets of autoantibodies in implant osseointegration.
The use of orthodontic cutters or debonding pliers does not affect the adhesive bond failure site and both techniques have a tendency to leave a significant amount of adhesive on the surface enamel. In the resin-reinforced glass ionomer cements, detachment occurs at the interface enamel-adhesive and this pattern of detachment increases the risk of the enamel damage during debonding. In both types of composite resins (photopolymerizable or self-curing), the detachment occurs at the interface bracketing adhesive. In this case the amount of remaining adhesive material on the tooth must be removed with further methods, which in addition, increase the risk of iatrogenic injury as well as the working hours.
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